Practical Leadership Seminar – Application

"*" indicates required fields

Personal Information

Name*

First Last

Father's Name*

Mother's Name*

Address*

Street Address City State ZIP Code

Home Phone Number*

Cell Phone Number

Phone Number of Parent (for emergency use)*

Email Address of Applicant

Email Address of Parent*

Date of Birth*

Education

High School*

Grade Point Average*

Extracurricular Activities*

Miscellaneous

Medical Insurance Company*

Medical Insurance Group Number*

Medical Insurance Policy Number*

Medical Insurance Phone Number*

Electronic Signature for Medical & Photo Release*

As the parent or legal guardian of the participant identified on this registration, I hereby delegate authority to the Directors of "Making Things Happen" to arrange whatever medical treatment they deem necessary for him during the activity. Also, I hereby authorize and consent to the use and reproduction by YSI staff or an authorized agent or assignee of any and all photographs taken of the above-named applicant for the purpose of promoting YSI programs, without any compensation to me. All film, together with any prints, shall constitute property of YSI, solely and completely.

Reference*

Who recommended this program to you?

Comments

Please include any dietary restrictions or medical conditions.

Essay*

Write an essay (e.g. 200 words) on one of the following topics:

1.) Identify someone who has exercised a leadership role in your life and describe his influence.
2.) What quality more than any others makes for a great leader?
3.) What historical figure do you admire as a leader and why?

Applications submitted without an essay will not be considered.

You may want to draft your essay prior to completing the online application and then copy and paste it into the box provided.